Letters to the Editor
In Reply
We thank Behringer et al. for their constructive commentary on our article (1). Our position is as follows.
The treating physicians’ assessment cannot be considered the gold standard for evaluating the level of care. The relevant results of our study show that patients are more critically assessed by SmED-Kontakt+, which points at a more safety oriented assessment on the part of the instrument.
We conclude that SmED-Kontakt+ can be used to redirect patients in emergency departments if “further care is provided promptly in established healthcare facilities with obligatory appointments and the care facilities to be contacted should be immediately accessible and appropriately equipped.”
This means that outpatient healthcare structures should be located in immediate physical proximity to the emergency room. The danger to patients in the context of the study was 0.1–1.5% (actual) and 0.1–1.6% (hypothetical), which equates to the usual error rate for elimination processes in emergency medicine. We don’t consider the correspondence by Behringer et al. as providing new arguments for not using SmED-Kontakt+. We specifically support defining an acceptable error rate and testing this for societal acceptance.
Instruments for the initial assessment in emergency departments (Manchester Triage System [MTS], Emergency Severity Index [ESI]) are unequivocally not suitable nor validated for onward referral. Patients whose care is assessed as slightly more urgent may wait longer to see a doctor in the emergency department, but they can often not be cared for using the resources of an independent practice. This is reflected in the high proportion of inpatient admissions even in the low triage categories. If instruments for redirecting patients are put to non-validated use, we can assume a high risk to patients and a high rate of patients who will have to be referred back to the emergency room.
DOI: 10.3238/arztebl.m2025.0009
On behalf of the authors
Prof. Dr. rer. medic. Anna Slagman
Notfallmedizinische Versorgungsforschung
Notfall- und Akutmedizin CVK, CCM
Charité Universitätsmedizin Berlin
anna.slagman@charite.de
Conflict of interest statement
AS is a member of the Expert Advisory Board of the Central Institute for Statutory Health Insurance Physicians in Germany and declares that she has received expense allowances for attending meetings of the Expert Advisory Board. AS also states that she has received further grants from the Central Institute for Statutory Health Insurance Physicians for conducting other studies. AS received grants from the German Research Foundation, the Federal Ministry of Education and Research, the Federal Ministry of Health, the Innovation fund of the Joint Federal Committee, the Berlin University Alliance, as well as from Thermo Fisher Scientific and Roche Diagnostics.
| 1. | Slagman A, Bremicker A, Möckel M, Eienbröker L, Fischer-Rosinský A, Gries A: Evaluation of an automated decision aid for the further referral of emergency room patients—a prospective cohort study. Dtsch Arztebl Int 2024; 121: 703–9 VOLLTEXT |
